Provider First Line Business Practice Location Address:
23009 56TH AVE W STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-778-0113
Provider Business Practice Location Address Fax Number:
425-778-8833
Provider Enumeration Date:
09/24/2021