Provider First Line Business Practice Location Address:
16202 64TH ST E
Provider Second Line Business Practice Location Address:
SUITE #101
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:
253-891-0977
Provider Business Practice Location Address Fax Number:
253-826-4613
Provider Enumeration Date:
01/03/2009