Provider First Line Business Practice Location Address:
1421 NW 85TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-3113
Provider Business Practice Location Address Fax Number:
206-789-7430
Provider Enumeration Date:
04/16/2007