Provider First Line Business Practice Location Address:
7120 40TH ST W
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
UNIVERISTY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-565-4312
Provider Business Practice Location Address Fax Number:
253-565-9925
Provider Enumeration Date:
09/13/2006