Provider First Line Business Practice Location Address:
6534 4TH AVE NE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-6470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-0588
Provider Business Practice Location Address Fax Number:
206-523-0590
Provider Enumeration Date:
10/04/2006