Provider First Line Business Practice Location Address:
85 NW ALDER PL STE A
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:
98027-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-362-8385
Provider Business Practice Location Address Fax Number:
503-362-8435
Provider Enumeration Date:
09/29/2016