Provider First Line Business Practice Location Address:
5325 BALLARD AVE NW STE 213
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:
98107-4193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-427-9710
Provider Business Practice Location Address Fax Number:
206-783-3077
Provider Enumeration Date:
12/27/2006