Provider First Line Business Practice Location Address:
8401 5TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-4180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-291-8377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2005