Provider First Line Business Practice Location Address:
4459 FREMONT AVE N STE 2
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:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-501-2092
Provider Business Practice Location Address Fax Number:
206-708-6638
Provider Enumeration Date:
02/20/2019