Provider First Line Business Practice Location Address:
6016 NE BOTHELL WAY STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-9403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-852-2866
Provider Business Practice Location Address Fax Number:
253-852-3102
Provider Enumeration Date:
08/26/2005