Provider First Line Business Practice Location Address:
18126 60TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-9402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-478-2887
Provider Business Practice Location Address Fax Number:
206-577-6409
Provider Enumeration Date:
01/11/2007