Provider First Line Business Practice Location Address:
13751 LAKE CITY WAY NE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-8612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-623-3814
Provider Business Practice Location Address Fax Number:
206-623-4327
Provider Enumeration Date:
05/22/2006