Provider First Line Business Practice Location Address:
134 188TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPANAWAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98387-4618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-847-2304
Provider Business Practice Location Address Fax Number:
253-847-2304
Provider Enumeration Date:
11/30/2005