Provider First Line Business Practice Location Address:
22002 64TH AVE W STE M2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-486-5108
Provider Business Practice Location Address Fax Number:
206-331-4193
Provider Enumeration Date:
03/15/2013