Provider First Line Business Practice Location Address:
3401 EVANSTON AVE N.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-459-1773
Provider Business Practice Location Address Fax Number:
206-783-4777
Provider Enumeration Date:
10/06/2006