Provider First Line Business Practice Location Address:
1570 N 115TH ST
Provider Second Line Business Practice Location Address:
SUITE PB 15
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-6591
Provider Business Practice Location Address Fax Number:
206-368-1191
Provider Enumeration Date:
12/28/2005