Provider First Line Business Practice Location Address:
12744 35TH AVE NE UNIT A
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:
98125-4508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-790-1590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2014