Provider First Line Business Practice Location Address:
2611 NE 125TH ST
Provider Second Line Business Practice Location Address:
SUITE 100B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-229-2764
Provider Business Practice Location Address Fax Number:
206-294-4946
Provider Enumeration Date:
12/18/2006