Provider First Line Business Practice Location Address:
5723 NE BOTHELL WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-9404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-2813
Provider Business Practice Location Address Fax Number:
425-483-1414
Provider Enumeration Date:
12/10/2010