Provider First Line Business Practice Location Address:
1216 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-618-6270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2012