Provider First Line Business Practice Location Address:
217 SW 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PRAIRIE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-886-7358
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2026