Provider First Line Business Practice Location Address:
5723 NE BOTHELL WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98028-9404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-485-0588
Provider Business Practice Location Address Fax Number:
425-483-6189
Provider Enumeration Date:
09/20/2006