Provider First Line Business Practice Location Address:
6808 220TH ST SW
Provider Second Line Business Practice Location Address:
NORTH START PLACE, STE 201
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-2187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-640-6976
Provider Business Practice Location Address Fax Number:
425-640-6977
Provider Enumeration Date:
06/14/2012