Provider First Line Business Practice Location Address:
17511 68TH AVENUE NE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-724-6760
Provider Business Practice Location Address Fax Number:
206-838-7330
Provider Enumeration Date:
12/01/2005