Provider First Line Business Practice Location Address:
1560 N 115TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-1244
Provider Business Practice Location Address Fax Number:
206-368-1270
Provider Enumeration Date:
07/17/2009