Provider First Line Business Practice Location Address:
12048 32ND AVE NE
Provider Second Line Business Practice Location Address:
SUITE #307
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-5557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-364-1073
Provider Business Practice Location Address Fax Number:
206-364-1073
Provider Enumeration Date:
05/29/2007