Provider First Line Business Practice Location Address:
930 NE HIGH ST
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:
98029-7417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-922-6192
Provider Business Practice Location Address Fax Number:
425-392-8858
Provider Enumeration Date:
09/29/2011