Provider First Line Business Practice Location Address:
1101 DEXTER AVE N SUITE 105
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:
98109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-814-6533
Provider Business Practice Location Address Fax Number:
206-596-0821
Provider Enumeration Date:
01/23/2008