Provider First Line Business Practice Location Address:
1160 N 198TH ST
Provider Second Line Business Practice Location Address:
# H 302
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-546-5905
Provider Business Practice Location Address Fax Number:
206-542-1808
Provider Enumeration Date:
01/02/2007