Provider First Line Business Practice Location Address:
11065 5TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-2224
Provider Business Practice Location Address Fax Number:
206-260-2701
Provider Enumeration Date:
06/25/2006