Provider First Line Business Practice Location Address:
22002 64TH AVE W BLDG 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-790-0195
Provider Business Practice Location Address Fax Number:
206-801-1029
Provider Enumeration Date:
01/06/2020