Provider First Line Business Practice Location Address:
1632 116TH AVE NE STE C
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:
98004-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-454-8191
Provider Business Practice Location Address Fax Number:
425-454-3037
Provider Enumeration Date:
05/26/2006