Provider First Line Business Practice Location Address:
1318 138TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILL CREEK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98012-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-276-2265
Provider Business Practice Location Address Fax Number:
425-385-2042
Provider Enumeration Date:
02/27/2007