Provider First Line Business Practice Location Address:
12217 NE 128TH ST
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:
98034-7301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-202-7254
Provider Business Practice Location Address Fax Number:
425-307-1291
Provider Enumeration Date:
10/29/2019