Provider First Line Business Practice Location Address:
6830 NE BOTHELL WAY
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-485-3051
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2007