Provider First Line Business Practice Location Address:
115 4TH AVE S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98020-3515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-778-2838
Provider Business Practice Location Address Fax Number:
425-778-2838
Provider Enumeration Date:
04/19/2010