Provider First Line Business Practice Location Address: 
970 5TH AVE NW STE 120
    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: 
98027-2487
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
425-276-0388
    Provider Business Practice Location Address Fax Number: 
425-276-0387
    Provider Enumeration Date: 
07/11/2014