Provider First Line Business Practice Location Address:
543 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98020-3162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-546-0805
Provider Business Practice Location Address Fax Number:
206-542-5893
Provider Enumeration Date:
11/13/2006