Provider First Line Business Practice Location Address:
11821 NE 128TH ST STE H
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:
98034-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-618-6549
Provider Business Practice Location Address Fax Number:
425-968-6367
Provider Enumeration Date:
03/10/2014