Provider First Line Business Practice Location Address:
11830 NE 128TH ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-821-9595
Provider Business Practice Location Address Fax Number:
425-821-3154
Provider Enumeration Date:
10/12/2006