Provider First Line Business Practice Location Address:
6016 NE BOTHELL WAY
Provider Second Line Business Practice Location Address:
STE G
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:
425-486-0658
Provider Business Practice Location Address Fax Number:
425-487-6761
Provider Enumeration Date:
07/21/2005