Provider First Line Business Practice Location Address:
22232 17TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE 209 CANYON PARK OFFICE CENTER
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98021-7411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-489-8274
Provider Business Practice Location Address Fax Number:
425-487-9506
Provider Enumeration Date:
09/26/2006