Provider First Line Business Practice Location Address:
11920 NE 195TH ST
Provider Second Line Business Practice Location Address:
SUITE 516
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98011-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-416-4421
Provider Business Practice Location Address Fax Number:
425-485-2247
Provider Enumeration Date:
09/30/2010