Provider First Line Business Practice Location Address:
4115 UNIVERSITY WAY NE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-6257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-299-1780
Provider Business Practice Location Address Fax Number:
206-524-9836
Provider Enumeration Date:
02/02/2007