Provider First Line Business Practice Location Address:
1318 138TH STREET SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILL CREEK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-280-8312
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2009