Provider First Line Business Practice Location Address:
15100 SE 38TH ST
Provider Second Line Business Practice Location Address:
RITEAID PHARMACY #5179
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-746-4028
Provider Business Practice Location Address Fax Number:
425-746-3703
Provider Enumeration Date:
06/02/2010