Provider First Line Business Practice Location Address:
747 N 185TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-542-1313
Provider Business Practice Location Address Fax Number:
206-546-0887
Provider Enumeration Date:
12/19/2006