Provider First Line Business Practice Location Address:
3340 NE 125TH ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-8911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-6696
Provider Business Practice Location Address Fax Number:
206-363-0072
Provider Enumeration Date:
03/07/2007