Provider First Line Business Practice Location Address:
1050 140TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-688-0223
Provider Business Practice Location Address Fax Number:
425-688-0323
Provider Enumeration Date:
05/30/2008