Provider First Line Business Practice Location Address:
1409 140TH PL NE
Provider Second Line Business Practice Location Address:
SUITE #106
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-614-1205
Provider Business Practice Location Address Fax Number:
425-641-5796
Provider Enumeration Date:
08/02/2006