Provider First Line Business Practice Location Address:
1031 LAKE WASHINGTON BLVD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98039-3925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-924-1144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2015