Provider First Line Business Practice Location Address:
8204 27TH ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-9262
Provider Business Practice Location Address Fax Number:
253-564-0996
Provider Enumeration Date:
02/02/2006