Provider First Line Business Practice Location Address:
5649 UNIVERSITY WAY NE STE UNIT
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:
98105-2619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-661-5654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2006