Provider First Line Business Practice Location Address:
3080 148TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-6420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-378-8190
Provider Business Practice Location Address Fax Number:
425-649-1523
Provider Enumeration Date:
09/30/2006