Provider First Line Business Practice Location Address:
6300 NINTH AVENUE NE
Provider Second Line Business Practice Location Address:
SUITE 353
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-8517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-527-6289
Provider Business Practice Location Address Fax Number:
206-892-9689
Provider Enumeration Date:
12/12/2006