Provider First Line Business Practice Location Address:
12707 SE 42ND ST APT B1
Provider Second Line Business Practice Location Address:
12707 SE 42ND ST. APT B1
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-1970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-401-1353
Provider Business Practice Location Address Fax Number:
425-401-1353
Provider Enumeration Date:
11/04/2010