Provider First Line Business Practice Location Address:
6823 OSWEGO PL NE STE 1
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:
98115-8408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-527-9709
Provider Business Practice Location Address Fax Number:
206-526-2991
Provider Enumeration Date:
02/24/2012