Provider First Line Business Practice Location Address:
11903 NE 128TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-7209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-960-4770
Provider Business Practice Location Address Fax Number:
866-998-1837
Provider Enumeration Date:
03/25/2014