Provider First Line Business Practice Location Address:
1006 FRYAR AVE STE B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-826-2923
Provider Business Practice Location Address Fax Number:
253-826-2916
Provider Enumeration Date:
10/04/2012