Provider First Line Business Practice Location Address:
6405 218TH ST SW STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-2422
Provider Business Practice Location Address Fax Number:
206-782-1311
Provider Enumeration Date:
01/24/2007