Provider First Line Business Practice Location Address:
16903 32ND PL NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155-5358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-4919
Provider Business Practice Location Address Fax Number:
206-367-7578
Provider Enumeration Date:
12/21/2005