Provider First Line Business Practice Location Address:
5723 NE BOTHELL WAY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-9404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-364-7181
Provider Business Practice Location Address Fax Number:
425-483-6056
Provider Enumeration Date:
05/22/2007