Provider First Line Business Practice Location Address:
19200 NORTH KELSEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272-1162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-805-4790
Provider Business Practice Location Address Fax Number:
425-805-4791
Provider Enumeration Date:
09/30/2005