Provider First Line Business Practice Location Address:
6639 NE 190TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-985-6619
Provider Business Practice Location Address Fax Number:
425-952-1965
Provider Enumeration Date:
09/02/2010