Provider First Line Business Practice Location Address:
7611 NE 165TH 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:
98028-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-219-5562
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2016