Provider First Line Business Practice Location Address:
16300 MILL CREEK BLVD
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:
425-215-9106
Provider Business Practice Location Address Fax Number:
208-664-9217
Provider Enumeration Date:
12/30/2013