Provider First Line Business Practice Location Address:
21801 44TH AVE W
Provider Second Line Business Practice Location Address:
MOUNTLAKE TERRACE HIGH SCHOOL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-431-1080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007