Provider First Line Business Practice Location Address:
11711 NE 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-454-9791
Provider Business Practice Location Address Fax Number:
425-453-2739
Provider Enumeration Date:
07/30/2010