Provider First Line Business Practice Location Address:
1130 140TH AVE NE
Provider Second Line Business Practice Location Address:
#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
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:
10/20/2006