Provider First Line Business Practice Location Address:
11919 NE 128TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-7204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-821-6655
Provider Business Practice Location Address Fax Number:
425-821-8836
Provider Enumeration Date:
12/22/2005