Provider First Line Business Practice Location Address:
4421 147TH PL NE
Provider Second Line Business Practice Location Address:
B4
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-7190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-985-1434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2010