Provider First Line Business Practice Location Address:
407 - 14TH AVE SE
Provider Second Line Business Practice Location Address:
PHYSICAL MEDICINE & REHABILITATION
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98371-9936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-697-2706
Provider Business Practice Location Address Fax Number:
253-697-5180
Provider Enumeration Date:
11/21/2006