Provider First Line Business Practice Location Address:
8500 15TH AVE NW STE A
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:
98117-3665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-706-5210
Provider Business Practice Location Address Fax Number:
206-706-5679
Provider Enumeration Date:
01/03/2010