Provider First Line Business Practice Location Address:
10740 MERIDIAN AVE N STE 110
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:
98133-9010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-659-8107
Provider Business Practice Location Address Fax Number:
206-764-2936
Provider Enumeration Date:
12/29/2009