Provider First Line Business Practice Location Address:
1945 16 TH AVE NE
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:
98029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-427-2898
Provider Business Practice Location Address Fax Number:
541-647-2171
Provider Enumeration Date:
08/28/2008