Provider First Line Business Practice Location Address:
121 112TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-455-3353
Provider Business Practice Location Address Fax Number:
425-455-3344
Provider Enumeration Date:
11/02/2006