Provider First Line Business Practice Location Address:
460 228TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAMMAMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98074-7209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
142-586-8902
Provider Business Practice Location Address Fax Number:
142-543-2144
Provider Enumeration Date:
08/30/2006