Provider First Line Business Practice Location Address:
1824 N. 203RD STREET
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:
98133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-629-4699
Provider Business Practice Location Address Fax Number:
888-972-9414
Provider Enumeration Date:
03/09/2007