Provider First Line Business Practice Location Address:
4026 NE 55TH ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-785-5887
Provider Business Practice Location Address Fax Number:
206-367-0627
Provider Enumeration Date:
01/21/2007