Provider First Line Business Practice Location Address:
909 N BROADWAY
Provider Second Line Business Practice Location Address:
PBO CREDENTIALING
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-317-0699
Provider Business Practice Location Address Fax Number:
425-317-0291
Provider Enumeration Date:
07/25/2006