Provider First Line Business Practice Location Address:
5413 MERIDIAN AVE N
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-6168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-545-7500
Provider Business Practice Location Address Fax Number:
206-632-4767
Provider Enumeration Date:
02/09/2007