Provider First Line Business Practice Location Address:
10522 LAKE CITY WAY NE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-7765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-349-9198
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2010