Provider First Line Business Practice Location Address:
318 2ND STREET SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-417-6795
Provider Business Practice Location Address Fax Number:
425-422-0495
Provider Enumeration Date:
02/14/2008