Provider First Line Business Practice Location Address:
17990 MIDVALE AVE N UNIT 213
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-524-5835
Provider Business Practice Location Address Fax Number:
562-245-5445
Provider Enumeration Date:
03/27/2023