Provider First Line Business Practice Location Address:
2611 NE 125TH ST
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-371-7325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007