Provider First Line Business Practice Location Address:
7351 126TH PL SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98056-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-277-1352
Provider Business Practice Location Address Fax Number:
206-764-2628
Provider Enumeration Date:
09/01/2006