Provider First Line Business Practice Location Address:
17455 68TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-673-9199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2015