Provider First Line Business Practice Location Address:
2611 NE 125TH ST
Provider Second Line Business Practice Location Address:
STE 225
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-361-6884
Provider Business Practice Location Address Fax Number:
206-361-1598
Provider Enumeration Date:
11/21/2006