Provider First Line Business Practice Location Address:
4455 148TH AVE. NE
Provider Second Line Business Practice Location Address:
BUILDING C, LOWER LEVEL
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-835-8983
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2007