Provider First Line Business Practice Location Address:
3414 1/2 FREMONT AVENUE N
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-472-9297
Provider Business Practice Location Address Fax Number:
888-965-5143
Provider Enumeration Date:
02/08/2011