Provider First Line Business Practice Location Address:
4615 196TH ST SW STE 114
Provider Second Line Business Practice Location Address:
FRED MEYER - REGIONAL OFFICE
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-582-4059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2012