Provider First Line Business Practice Location Address:
EVERGREEN SURGERY AND PHYSICIAN'S CENTER TAN 240
Provider Second Line Business Practice Location Address:
12040 NE 128TH ST
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-2210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007