Provider First Line Business Practice Location Address:
3950 MONTLAKE BLVD NE
Provider Second Line Business Practice Location Address:
ROOM 148
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-1552
Provider Business Practice Location Address Fax Number:
206-543-6573
Provider Enumeration Date:
09/15/2006