Provider First Line Business Practice Location Address:
12040 NE 128TH ST
Provider Second Line Business Practice Location Address:
MS -23
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-1868
Provider Business Practice Location Address Fax Number:
425-899-2250
Provider Enumeration Date:
01/26/2017