Provider First Line Business Practice Location Address:
10135 NE 112TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033-4458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-227-0058
Provider Business Practice Location Address Fax Number:
425-576-1110
Provider Enumeration Date:
04/11/2007