Provider First Line Business Practice Location Address:
22142 SE 237TH ST.
Provider Second Line Business Practice Location Address:
SUITE #8
Provider Business Practice Location Address City Name:
MAPLE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98038-6405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-433-6073
Provider Business Practice Location Address Fax Number:
425-433-6074
Provider Enumeration Date:
01/19/2007