Provider First Line Business Practice Location Address:
4455 148TH AVENUE NE
Provider Second Line Business Practice Location Address:
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:
425-861-6255
Provider Business Practice Location Address Fax Number:
425-869-5285
Provider Enumeration Date:
08/26/2009