Provider First Line Business Practice Location Address:
12733 LAKE CITY WAY NE STE 301
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:
98125-4490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-5060
Provider Business Practice Location Address Fax Number:
206-417-3047
Provider Enumeration Date:
09/11/2015