Provider First Line Business Practice Location Address:
5108 196TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-778-4174
Provider Business Practice Location Address Fax Number:
425-775-8416
Provider Enumeration Date:
10/10/2006