Provider First Line Business Practice Location Address:
6501 196TH ST SW STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-775-2288
Provider Business Practice Location Address Fax Number:
425-778-5476
Provider Enumeration Date:
10/17/2006