Provider First Line Business Practice Location Address:
17962 MIDVALE AVE N
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-4925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-546-9310
Provider Business Practice Location Address Fax Number:
206-546-9311
Provider Enumeration Date:
02/20/2009