Provider First Line Business Practice Location Address:
5017 196TH ST SW
Provider Second Line Business Practice Location Address:
STE. 209
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-6123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-755-5239
Provider Business Practice Location Address Fax Number:
360-221-4190
Provider Enumeration Date:
01/24/2007