Provider First Line Business Practice Location Address:
11011 MERIDIAN AV NORTH
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-859-5777
Provider Business Practice Location Address Fax Number:
206-859-5776
Provider Enumeration Date:
12/18/2006