Provider First Line Business Practice Location Address:
3333 WALLINGFORD AVE. N.
Provider Second Line Business Practice Location Address:
SUITE C-3
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-9052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-8382
Provider Business Practice Location Address Fax Number:
206-322-6654
Provider Enumeration Date:
04/18/2007