Provider First Line Business Practice Location Address:
13118 121ST WAY NE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-793-9776
Provider Business Practice Location Address Fax Number:
360-793-7697
Provider Enumeration Date:
08/29/2006