Provider First Line Business Practice Location Address:
5343 TALLMAN AVE NW
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-783-7771
Provider Business Practice Location Address Fax Number:
206-783-1468
Provider Enumeration Date:
02/23/2007