Provider First Line Business Practice Location Address:
5017 196TH ST SW
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-778-5665
Provider Business Practice Location Address Fax Number:
425-778-3356
Provider Enumeration Date:
05/15/2006