Provider First Line Business Practice Location Address:
16505 SE 30TH ST
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98008-5625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-643-4669
Provider Business Practice Location Address Fax Number:
425-643-8693
Provider Enumeration Date:
04/19/2007