Provider First Line Business Practice Location Address:
110 JAMES ST
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98020-8430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-459-1158
Provider Business Practice Location Address Fax Number:
888-296-8140
Provider Enumeration Date:
11/07/2009