Provider First Line Business Practice Location Address:
15585 NE 24TH ST
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:
98007-3836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-781-6080
Provider Business Practice Location Address Fax Number:
206-781-6285
Provider Enumeration Date:
06/20/2011