Provider First Line Business Practice Location Address:
11711 NE 12TH STREET
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-454-1405
Provider Business Practice Location Address Fax Number:
425-635-9340
Provider Enumeration Date:
11/24/2006