Provider First Line Business Practice Location Address:
731 123RD AVE NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-454-2238
Provider Business Practice Location Address Fax Number:
425-455-8482
Provider Enumeration Date:
04/20/2009