Provider First Line Business Practice Location Address:
12911 120TH AVE NE STE C50
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:
98034-3080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-3234
Provider Business Practice Location Address Fax Number:
425-899-3235
Provider Enumeration Date:
10/27/2005