Provider First Line Business Practice Location Address:
1445 NW MALL STREET
Provider Second Line Business Practice Location Address:
STE. 1
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-391-9211
Provider Business Practice Location Address Fax Number:
425-391-9545
Provider Enumeration Date:
04/23/2007