Provider First Line Business Practice Location Address:
1310 116TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-250-1145
Provider Business Practice Location Address Fax Number:
425-823-6028
Provider Enumeration Date:
07/24/2006