Provider First Line Business Practice Location Address:
22315 HWY 99 N
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-771-3266
Provider Business Practice Location Address Fax Number:
425-774-7917
Provider Enumeration Date:
12/16/2005