Provider First Line Business Practice Location Address:
10740 MERIDIAN AVE N
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-9010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-2088
Provider Business Practice Location Address Fax Number:
206-523-1415
Provider Enumeration Date:
02/02/2007