Provider First Line Business Practice Location Address:
1520 15TH STREET NW
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-244-7720
Provider Business Practice Location Address Fax Number:
425-226-4326
Provider Enumeration Date:
12/20/2007