Provider First Line Business Practice Location Address:
22840 NE 8TH STREET
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAMMAMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98074-7263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-898-8540
Provider Business Practice Location Address Fax Number:
425-898-1570
Provider Enumeration Date:
07/07/2005