Provider First Line Business Practice Location Address:
320 NE 97TH ST.
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-1010
Provider Business Practice Location Address Fax Number:
206-523-1330
Provider Enumeration Date:
08/21/2006