Provider First Line Business Practice Location Address: 
7530 164TH AVE. NE
    Provider Second Line Business Practice Location Address: 
SUITE #A215
    Provider Business Practice Location Address City Name: 
REDMOND
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98052
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
425-885-9292
    Provider Business Practice Location Address Fax Number: 
425-885-9106
    Provider Enumeration Date: 
05/13/2013