Provider First Line Business Practice Location Address:
13622 NE 20TH ST STE A
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:
98005-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-406-6556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2006