Provider First Line Business Practice Location Address:
2366 EASTLAKE AVE E
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-7864
Provider Business Practice Location Address Fax Number:
206-323-7397
Provider Enumeration Date:
02/26/2007