Provider First Line Business Practice Location Address:
5920 100TH ST SW STE 22
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:
98499-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-581-1442
Provider Business Practice Location Address Fax Number:
253-449-0564
Provider Enumeration Date:
11/09/2006