Provider First Line Business Practice Location Address:
19505 52ND AVE W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-623-3814
Provider Business Practice Location Address Fax Number:
206-623-4327
Provider Enumeration Date:
04/14/2006