Provider First Line Business Practice Location Address:
11711 NE 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 2-B
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:
425-637-1022
Provider Business Practice Location Address Fax Number:
425-637-2011
Provider Enumeration Date:
11/30/2006