Provider First Line Business Practice Location Address:
11919 NE 128TH ST STE A
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:
98034-7204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-2020
Provider Business Practice Location Address Fax Number:
206-215-2022
Provider Enumeration Date:
11/04/2010