Provider First Line Business Practice Location Address:
16850 SE 272ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-4931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-395-1960
Provider Business Practice Location Address Fax Number:
253-395-2013
Provider Enumeration Date:
08/31/2007