Provider First Line Business Practice Location Address:
2445 140TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE B-105
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-1879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-644-6328
Provider Business Practice Location Address Fax Number:
425-644-6295
Provider Enumeration Date:
10/03/2007