Provider First Line Business Practice Location Address:
17 148TH AVE SE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-644-6478
Provider Business Practice Location Address Fax Number:
425-644-6476
Provider Enumeration Date:
10/26/2006