Provider First Line Business Practice Location Address:
21907 64TH AVE. W
Provider Second Line Business Practice Location Address:
SUITE # 110
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-673-5220
Provider Business Practice Location Address Fax Number:
425-673-1597
Provider Enumeration Date:
01/12/2007