Provider First Line Business Practice Location Address:
19802 NE 148TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98077-7698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-882-1554
Provider Business Practice Location Address Fax Number:
425-883-1818
Provider Enumeration Date:
03/26/2007