Provider First Line Business Practice Location Address:
20120 BALLINGER WAY NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-9000
Provider Business Practice Location Address Fax Number:
206-365-9001
Provider Enumeration Date:
06/27/2012