Provider First Line Business Practice Location Address:
4520 42ND AVE SW STE 33
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:
98116-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-935-3161
Provider Business Practice Location Address Fax Number:
206-933-8453
Provider Enumeration Date:
03/19/2014