Provider First Line Business Practice Location Address:
22002 64TH AVE W
Provider Second Line Business Practice Location Address:
SUITE M-11A
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:
425-750-1447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2014