Provider First Line Business Practice Location Address:
12309 15TH AVE NE STE C
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:
98125-4864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-1010
Provider Business Practice Location Address Fax Number:
206-367-1002
Provider Enumeration Date:
10/17/2007