Provider First Line Business Practice Location Address:
1570 N 115TH ST
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-4533
Provider Business Practice Location Address Fax Number:
206-362-2434
Provider Enumeration Date:
07/01/2005