Provider First Line Business Practice Location Address:
14524 BOTHELL WAY NE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-292-2771
Provider Business Practice Location Address Fax Number:
206-292-2133
Provider Enumeration Date:
10/02/2006