Provider First Line Business Practice Location Address:
12282 NE 12TH LN
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:
98005-2380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-718-9792
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2026