Provider First Line Business Practice Location Address:
6700 NE 182ND ST
Provider Second Line Business Practice Location Address:
C308
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-4841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-772-2613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2007