Provider First Line Business Practice Location Address:
2611 NE 125TH ST STE 90
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-362-0035
Provider Business Practice Location Address Fax Number:
206-362-6927
Provider Enumeration Date:
03/28/2007