Provider First Line Business Practice Location Address:
22315 HIGHWAY 99
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-8003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-712-0307
Provider Business Practice Location Address Fax Number:
425-749-7102
Provider Enumeration Date:
07/08/2011