Provider First Line Business Practice Location Address:
5605 100TH ST SW
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-284-9800
Provider Business Practice Location Address Fax Number:
253-284-9801
Provider Enumeration Date:
10/16/2013