Provider First Line Business Practice Location Address:
1417 NW 54TH STREET, SUITE 252
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:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-297-6245
Provider Business Practice Location Address Fax Number:
425-739-4778
Provider Enumeration Date:
10/20/2006