Provider First Line Business Practice Location Address:
1405 NW 85TH ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98117-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-1881
Provider Business Practice Location Address Fax Number:
206-789-0336
Provider Enumeration Date:
11/30/2006