Provider First Line Business Practice Location Address:
1536 N 115TH STREET
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
819-674-7265
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2014