Provider First Line Business Practice Location Address:
5224 WILSON AVE S
Provider Second Line Business Practice Location Address:
STE 101B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98118-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-721-7880
Provider Business Practice Location Address Fax Number:
206-721-7788
Provider Enumeration Date:
02/13/2007