Provider First Line Business Practice Location Address:
745 N 180TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-542-3666
Provider Business Practice Location Address Fax Number:
206-542-6333
Provider Enumeration Date:
10/30/2026