Provider First Line Business Practice Location Address:
5621 UNIVERSITY WAY NE
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:
98105-2619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-729-1405
Provider Business Practice Location Address Fax Number:
206-324-0543
Provider Enumeration Date:
05/24/2007