Provider First Line Business Practice Location Address:
1248 112TH AVE 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:
98004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-453-7424
Provider Business Practice Location Address Fax Number:
425-646-0799
Provider Enumeration Date:
08/28/2008