Provider First Line Business Practice Location Address:
30 LAKE SHORE PLZ STE B
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:
98033-6175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-629-8882
Provider Business Practice Location Address Fax Number:
425-822-4325
Provider Enumeration Date:
06/18/2007