Provider First Line Business Practice Location Address:
19655 1ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NORMANDY PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98148-2166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-200-7042
Provider Business Practice Location Address Fax Number:
206-212-7626
Provider Enumeration Date:
10/16/2007