Provider First Line Business Practice Location Address:
17833 1ST AVE S STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMANDY PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-246-0040
Provider Business Practice Location Address Fax Number:
206-246-0070
Provider Enumeration Date:
05/16/2012