Provider First Line Business Practice Location Address:
26401 PACIFIC HWY S.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-870-3590
Provider Business Practice Location Address Fax Number:
253-839-1312
Provider Enumeration Date:
10/19/2012