Provider First Line Business Practice Location Address:
1530 N 115TH ST SUITE 207
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-3058
Provider Business Practice Location Address Fax Number:
206-523-1252
Provider Enumeration Date:
12/08/2006