Provider First Line Business Practice Location Address:
13344 1ST AVE NE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-362-3404
Provider Business Practice Location Address Fax Number:
206-362-2892
Provider Enumeration Date:
02/21/2007