Provider First Line Business Practice Location Address:
19503 56TH AVE W
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-776-8303
Provider Business Practice Location Address Fax Number:
425-776-8363
Provider Enumeration Date:
01/30/2008