Provider First Line Business Practice Location Address:
11000 NE 10TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-8554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-283-5871
Provider Business Practice Location Address Fax Number:
425-450-7005
Provider Enumeration Date:
12/04/2007