Provider First Line Business Practice Location Address:
11524 15TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-6357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-3700
Provider Business Practice Location Address Fax Number:
206-367-0406
Provider Enumeration Date:
02/08/2007