Provider First Line Business Practice Location Address:
1560 N. 115TH STREET
Provider Second Line Business Practice Location Address:
SUITE G16B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-606-5800
Provider Business Practice Location Address Fax Number:
206-606-2825
Provider Enumeration Date:
12/26/2012