Provider First Line Business Practice Location Address:
9600 SHARON DR
Provider Second Line Business Practice Location Address:
HOUSE 1 - EXPLORER MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98204-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-356-1228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2012