Provider First Line Business Practice Location Address:
5101 25TH AVE NE STE 10
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:
98105-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-432-9051
Provider Business Practice Location Address Fax Number:
206-432-9264
Provider Enumeration Date:
07/28/2005