Provider First Line Business Practice Location Address:
3525 ENSIGN RD NE
Provider Second Line Business Practice Location Address:
MEDICAL RESOURCE CENTER SUITE G
Provider Business Practice Location Address City Name:
OLY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-456-2177
Provider Business Practice Location Address Fax Number:
360-877-9603
Provider Enumeration Date:
06/19/2008