Provider First Line Business Practice Location Address:
6815 NE 204TH ST
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:
98028-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-356-8550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2011