Provider First Line Business Practice Location Address:
1551 NW 54TH
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-1828
Provider Business Practice Location Address Fax Number:
206-789-1829
Provider Enumeration Date:
04/27/2006