Provider First Line Business Practice Location Address:
5017 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:
98036-6123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-776-1169
Provider Business Practice Location Address Fax Number:
425-776-1167
Provider Enumeration Date:
11/21/2005