Provider First Line Business Practice Location Address:
16202 64TH ST E
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-3028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-470-5020
Provider Business Practice Location Address Fax Number:
253-470-5069
Provider Enumeration Date:
08/15/2005