Provider First Line Business Practice Location Address:
6808 220TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-719-5759
Provider Business Practice Location Address Fax Number:
425-670-6578
Provider Enumeration Date:
01/24/2011