Provider First Line Business Practice Location Address:
1709 30TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98029-7365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-392-2147
Provider Business Practice Location Address Fax Number:
425-392-8197
Provider Enumeration Date:
02/25/2007