Provider First Line Business Practice Location Address:
6412 20TH STREET COURT WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FIRCREST
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-6227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-566-8800
Provider Business Practice Location Address Fax Number:
253-566-7092
Provider Enumeration Date:
01/08/2007