Provider First Line Business Practice Location Address:
12623 NE 110TH 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:
98033-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-827-1144
Provider Business Practice Location Address Fax Number:
425-827-1144
Provider Enumeration Date:
08/14/2007