Provider First Line Business Practice Location Address:
5519 UNIVERSITY WAY NE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-3562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-6095
Provider Business Practice Location Address Fax Number:
206-527-6227
Provider Enumeration Date:
07/22/2009