Provider First Line Business Practice Location Address:
8221 5TH AVE NE STE 1
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:
98115-4190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-2811
Provider Business Practice Location Address Fax Number:
206-525-2812
Provider Enumeration Date:
10/16/2007