Provider First Line Business Practice Location Address:
1611 116TH AVE. NE.
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-335-4993
Provider Business Practice Location Address Fax Number:
425-697-6767
Provider Enumeration Date:
03/31/2006