Provider First Line Business Practice Location Address:
6920 COAL CREEK PKWY SE
Provider Second Line Business Practice Location Address:
STE 12
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98059-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-656-4095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006