Provider First Line Business Practice Location Address: 
16300 MILL CREEK BLVD STE 118
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MILL CREEK
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98012-1278
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
425-742-2900
    Provider Business Practice Location Address Fax Number: 
425-745-0740
    Provider Enumeration Date: 
07/18/2014