Provider First Line Business Practice Location Address:
1508 136TH STREET SOUTHEAST
Provider Second Line Business Practice Location Address:
HENRY M. JACKSON HIGH SCHOOL
Provider Business Practice Location Address City Name:
MILLCREEK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98208-8004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-385-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006