Provider First Line Business Practice Location Address:
5006 E LAKE SAMMAMISH PKWY SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98029-9220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-391-7645
Provider Business Practice Location Address Fax Number:
425-391-7699
Provider Enumeration Date:
10/30/2024