Provider First Line Business Practice Location Address:
6534 4TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-6440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-0587
Provider Business Practice Location Address Fax Number:
206-523-0590
Provider Enumeration Date:
07/22/2006