Provider First Line Business Practice Location Address:
12317 15TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-957-1881
Provider Business Practice Location Address Fax Number:
206-957-1895
Provider Enumeration Date:
12/13/2007