Provider First Line Business Practice Location Address:
1628 DEXTER 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:
98109-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-295-0123
Provider Business Practice Location Address Fax Number:
206-789-8846
Provider Enumeration Date:
03/30/2008