Provider First Line Business Practice Location Address:
12542 5TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-655-7925
Provider Business Practice Location Address Fax Number:
425-655-7949
Provider Enumeration Date:
01/08/2019