Provider First Line Business Practice Location Address:
110 MAIN ST STE 104
Provider Second Line Business Practice Location Address:
PACIFIC MENTAL HEALTH
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98020-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-427-9796
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2011