Provider First Line Business Practice Location Address:
8001 14TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-687-9239
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2020