Provider First Line Business Practice Location Address:
2611 NE 125TH ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-275-2637
Provider Business Practice Location Address Fax Number:
206-299-2289
Provider Enumeration Date:
10/09/2008