Provider First Line Business Practice Location Address:
125 130TH ST SE
Provider Second Line Business Practice Location Address:
#202, NEUROSCIENCE MEDICAL CENTER
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-357-8964
Provider Business Practice Location Address Fax Number:
425-379-2624
Provider Enumeration Date:
03/10/2010