Provider First Line Business Practice Location Address:
6505 NE 182ND ST
Provider Second Line Business Practice Location Address:
APT. 201
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-4871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-861-3937
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2008