Provider First Line Business Practice Location Address:
15224 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 301EVERGREEN FAMILY DENTAL
Provider Business Practice Location Address City Name:
MILL CREEK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-338-4999
Provider Business Practice Location Address Fax Number:
425-338-1055
Provider Enumeration Date:
02/26/2008