Provider First Line Business Practice Location Address:
5520 BRIDGEPORT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-206-5200
Provider Business Practice Location Address Fax Number:
971-206-5203
Provider Enumeration Date:
12/21/2009