Provider First Line Business Practice Location Address:
800 LOGAN AVE N
Provider Second Line Business Practice Location Address:
BUILDING 4-04, MEDICAL
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055-2080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-237-1333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006