Provider First Line Business Practice Location Address:
6720 EAST GREEN LAKE WAY N
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:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-9666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2014