Provider First Line Business Practice Location Address:
4501 INTERLAKE AVE N STE 8
Provider Second Line Business Practice Location Address:
#115
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-905-8575
Provider Business Practice Location Address Fax Number:
206-905-8554
Provider Enumeration Date:
12/26/2006