Provider First Line Business Practice Location Address:
1306 N 175TH ST
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-5019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-542-2149
Provider Business Practice Location Address Fax Number:
206-542-4802
Provider Enumeration Date:
02/16/2010