Provider First Line Business Practice Location Address:
19217 36TH AVE W.
Provider Second Line Business Practice Location Address:
BLDG 5, SUITE 106
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-582-7678
Provider Business Practice Location Address Fax Number:
425-582-7032
Provider Enumeration Date:
04/18/2007