Provider First Line Business Practice Location Address:
5116 196TH ST SW
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-771-0165
Provider Business Practice Location Address Fax Number:
425-670-1185
Provider Enumeration Date:
05/09/2007