Provider First Line Business Practice Location Address:
12415 LAKE CITY BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98498-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-232-4727
Provider Business Practice Location Address Fax Number:
253-590-0837
Provider Enumeration Date:
03/17/2006