Provider First Line Business Practice Location Address:
5005 200TH ST SW STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-807-7464
Provider Business Practice Location Address Fax Number:
206-385-3733
Provider Enumeration Date:
01/07/2010