Provider First Line Business Practice Location Address:
900 LENORA ST
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98121-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-402-5490
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2013