Provider First Line Business Practice Location Address:
12612 SE 85TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98056-9194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-775-5033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2023