Provider First Line Business Practice Location Address:
164 NE 145TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-3292
Provider Business Practice Location Address Fax Number:
206-367-8818
Provider Enumeration Date:
11/01/2006