Provider First Line Business Practice Location Address:
13400 NE 20TH ST STE 28
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:
98005-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-644-2056
Provider Business Practice Location Address Fax Number:
425-641-7081
Provider Enumeration Date:
12/21/2006