Provider First Line Business Practice Location Address:
2111 N NORTHGATE WAY STE 221
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:
98133-9018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-8012
Provider Business Practice Location Address Fax Number:
206-525-8013
Provider Enumeration Date:
01/24/2019