Provider First Line Business Practice Location Address:
6603 220TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 1C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-776-1056
Provider Business Practice Location Address Fax Number:
485-776-4357
Provider Enumeration Date:
06/20/2008