Provider First Line Business Practice Location Address:
7214 NE 155TH 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:
98028-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-617-4492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2012