Provider First Line Business Practice Location Address:
5343 TALLMAN AVE NW
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-7448
Provider Business Practice Location Address Fax Number:
206-706-0899
Provider Enumeration Date:
05/15/2008