Provider First Line Business Practice Location Address:
6160 NE 185TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-8910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-456-7204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2009