Provider First Line Business Practice Location Address:
1239 120TH AVE NE 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:
98005-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-352-9696
Provider Business Practice Location Address Fax Number:
385-287-1035
Provider Enumeration Date:
07/31/2023