Provider First Line Business Practice Location Address:
2475 140TH AVE NE BLDG C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-1892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-460-5634
Provider Business Practice Location Address Fax Number:
253-277-9635
Provider Enumeration Date:
06/28/2017