Provider First Line Business Practice Location Address:
1600 116TH AVE NE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-215-2288
Provider Business Practice Location Address Fax Number:
206-215-2289
Provider Enumeration Date:
10/23/2007