Provider First Line Business Practice Location Address:
402 NE 72ND ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-5456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-384-8604
Provider Business Practice Location Address Fax Number:
888-978-5162
Provider Enumeration Date:
05/03/2012