Provider First Line Business Practice Location Address:
195 - 1ST PLACE N.W.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-736-7630
Provider Business Practice Location Address Fax Number:
425-391-1174
Provider Enumeration Date:
09/10/2009