Provider First Line Business Practice Location Address:
22502 NE 28TH ST
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:
98074-6404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-715-1034
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2012