Provider First Line Business Practice Location Address:
22010 SE 248TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-432-1272
Provider Business Practice Location Address Fax Number:
425-413-4282
Provider Enumeration Date:
09/27/2010