Provider First Line Business Practice Location Address:
11903 NE 128TH SREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-298-3363
Provider Business Practice Location Address Fax Number:
425-825-1406
Provider Enumeration Date:
12/13/2006