Provider First Line Business Practice Location Address:
12917 S.E. 38TH ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-747-8052
Provider Business Practice Location Address Fax Number:
425-562-7222
Provider Enumeration Date:
09/20/2006