Provider First Line Business Practice Location Address:
320 NE 97TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-8113
Provider Business Practice Location Address Fax Number:
306-323-1457
Provider Enumeration Date:
09/05/2006