Provider First Line Business Practice Location Address:
1530 N 115TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-5935
Provider Business Practice Location Address Fax Number:
206-368-5934
Provider Enumeration Date:
04/24/2006