Provider First Line Business Practice Location Address:
5508 234TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-4746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-818-3223
Provider Business Practice Location Address Fax Number:
425-670-5256
Provider Enumeration Date:
09/28/2010