Provider First Line Business Practice Location Address:
19635 40TH PL NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE FOREST PARK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-989-2100
Provider Business Practice Location Address Fax Number:
206-366-0448
Provider Enumeration Date:
02/01/2007