Provider First Line Business Practice Location Address:
195 1ST PL NW
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-3285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-227-6329
Provider Business Practice Location Address Fax Number:
425-391-1174
Provider Enumeration Date:
02/27/2007