Provider First Line Business Practice Location Address:
25803 SE 138TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-6758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-829-2214
Provider Business Practice Location Address Fax Number:
425-391-8840
Provider Enumeration Date:
08/22/2007