Provider First Line Business Practice Location Address:
1118 1ST ST
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:
98033-5415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-822-8159
Provider Business Practice Location Address Fax Number:
425-803-0143
Provider Enumeration Date:
10/30/2012