Provider First Line Business Practice Location Address:
12356 NORTHUP WAY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-556-0484
Provider Business Practice Location Address Fax Number:
425-529-9651
Provider Enumeration Date:
06/27/2011