Provider First Line Business Practice Location Address:
11420 NE 20TH ST STE A
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:
98004-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
452-688-5777
Provider Business Practice Location Address Fax Number:
425-369-1435
Provider Enumeration Date:
07/08/2006