Provider First Line Business Practice Location Address:
4746 44TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98116-4489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-445-3424
Provider Business Practice Location Address Fax Number:
360-445-3424
Provider Enumeration Date:
06/19/2009