Provider First Line Business Practice Location Address:
5630 NE 198TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-599-4642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2013