Provider First Line Business Practice Location Address:
9709 3RD AVE NE
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-729-7315
Provider Business Practice Location Address Fax Number:
866-895-7142
Provider Enumeration Date:
07/21/2009