Provider First Line Business Practice Location Address:
5701 NE BOTHELL WAY
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-9400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-488-1405
Provider Business Practice Location Address Fax Number:
425-486-6432
Provider Enumeration Date:
08/18/2006