Provider First Line Business Practice Location Address:
3610 142ND PL 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:
98007-3231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-446-2202
Provider Business Practice Location Address Fax Number:
206-446-2202
Provider Enumeration Date:
08/06/2026