Provider First Line Business Practice Location Address:
5027 NE 188TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-481-5853
Provider Business Practice Location Address Fax Number:
425-481-5763
Provider Enumeration Date:
05/17/2007