Provider First Line Business Practice Location Address:
6701 139TH PL SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-742-2218
Provider Business Practice Location Address Fax Number:
425-742-8115
Provider Enumeration Date:
11/21/2006