Provider First Line Business Practice Location Address:
6100 219TH ST SW
Provider Second Line Business Practice Location Address:
STE 480
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-582-5642
Provider Business Practice Location Address Fax Number:
425-224-2758
Provider Enumeration Date:
08/21/2013