Provider First Line Business Practice Location Address:
1207 N 200TH ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-293-2961
Provider Business Practice Location Address Fax Number:
425-379-2382
Provider Enumeration Date:
10/23/2006