Provider First Line Business Practice Location Address: 
135 N OLYMPIC AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ARLINGTON
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98223-1335
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
360-659-8261
    Provider Business Practice Location Address Fax Number: 
360-659-1385
    Provider Enumeration Date: 
02/08/2007