Provider First Line Business Practice Location Address:
1121 124TH AVE NE
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:
98005-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-467-8607
Provider Business Practice Location Address Fax Number:
623-869-1249
Provider Enumeration Date:
10/28/2008