Provider First Line Business Practice Location Address:
1560 N 115TH ST STE G5
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:
98133-8414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-1626
Provider Business Practice Location Address Fax Number:
206-368-1631
Provider Enumeration Date:
04/03/2007