Provider First Line Business Practice Location Address:
19703 1ST AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMANDY PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-824-4700
Provider Business Practice Location Address Fax Number:
206-824-0410
Provider Enumeration Date:
01/05/2007