Provider First Line Business Practice Location Address:
120 LAKESIDE AVE
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-6534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-925-3762
Provider Business Practice Location Address Fax Number:
206-324-3600
Provider Enumeration Date:
07/14/2011