Provider First Line Business Practice Location Address:
10219 196TH ST CT E
Provider Second Line Business Practice Location Address:
SUITE # A, MAIL BOX # 2
Provider Business Practice Location Address City Name:
GRAHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98338-0118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-271-7313
Provider Business Practice Location Address Fax Number:
206-333-0978
Provider Enumeration Date:
01/22/2007