Provider First Line Business Practice Location Address:
10221 318TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARNATION
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98014-9714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-949-8414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2008