Provider First Line Business Practice Location Address: 
18730 33RD AVE W STE 200
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LYNNWOOD
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98037-4756
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
425-367-2126
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/19/2011