Provider First Line Business Practice Location Address:
121 112TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-454-4610
Provider Business Practice Location Address Fax Number:
425-454-5144
Provider Enumeration Date:
11/27/2006