Provider First Line Business Practice Location Address:
12412 NE 112TH PL
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:
98033-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-821-3966
Provider Business Practice Location Address Fax Number:
425-821-3966
Provider Enumeration Date:
10/23/2006