Provider First Line Business Practice Location Address:
23601 HIGHWAY 99 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-9212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-714-4476
Provider Business Practice Location Address Fax Number:
425-732-4476
Provider Enumeration Date:
11/15/2012