Provider First Line Business Practice Location Address:
12733 LAKE CITY WAY N.E. AVE.
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-5060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2008