Provider First Line Business Practice Location Address:
822A NE NORTHGATE WAY
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:
98125-7312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-462-6255
Provider Business Practice Location Address Fax Number:
206-462-6257
Provider Enumeration Date:
01/04/2013