Provider First Line Business Practice Location Address:
12310 NE 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-3185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-455-0001
Provider Business Practice Location Address Fax Number:
425-462-7387
Provider Enumeration Date:
09/21/2005