Provider First Line Business Practice Location Address:
1722 138TH PL NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-759-9544
Provider Business Practice Location Address Fax Number:
253-759-9512
Provider Enumeration Date:
07/29/2011