Provider First Line Business Practice Location Address:
22002 64TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 12
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:
425-778-6561
Provider Business Practice Location Address Fax Number:
425-743-3117
Provider Enumeration Date:
11/16/2006