Provider First Line Business Practice Location Address:
2021 NE 90TH ST
Provider Second Line Business Practice Location Address:
A203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-8230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-500-4740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2009