Provider First Line Business Practice Location Address:
11066 5TH AVE NE
Provider Second Line Business Practice Location Address:
STE #106
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:
206-365-6860
Provider Business Practice Location Address Fax Number:
206-365-0832
Provider Enumeration Date:
08/16/2006