Provider First Line Business Practice Location Address:
1130 140TH AVE NE STE 100B
Provider Second Line Business Practice Location Address:
1130 140TH AVE. NE, #100B
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-746-6090
Provider Business Practice Location Address Fax Number:
425-747-9856
Provider Enumeration Date:
09/14/2007