Provider First Line Business Practice Location Address:
17692 1ST AVE. SOUTH
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-241-0477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2008