Provider First Line Business Practice Location Address:
6133 NE 188TH PL
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:
98028-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-855-3465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2005