Provider First Line Business Practice Location Address:
7025 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-565-1019
Provider Business Practice Location Address Fax Number:
253-565-0279
Provider Enumeration Date:
10/19/2010