Provider First Line Business Practice Location Address:
8266 LAKE CITY WAY #C3
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:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-683-5083
Provider Business Practice Location Address Fax Number:
866-825-4679
Provider Enumeration Date:
11/24/2006