Provider First Line Business Practice Location Address:
7215 116TH AVE SE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-474-3192
Provider Business Practice Location Address Fax Number:
425-278-0628
Provider Enumeration Date:
02/06/2007