Provider First Line Business Practice Location Address:
17962 MIDVALE AVE. N
Provider Second Line Business Practice Location Address:
#223
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:
206-817-4794
Provider Business Practice Location Address Fax Number:
206-902-1322
Provider Enumeration Date:
01/23/2014