Provider First Line Business Practice Location Address:
2611 NE 125TH ST STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-4701
Provider Business Practice Location Address Fax Number:
360-730-1356
Provider Enumeration Date:
12/14/2006