Provider First Line Business Practice Location Address:
12740 33RD AVE NE
Provider Second Line Business Practice Location Address:
MCDERMOTT PLACE
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-6581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-302-2891
Provider Business Practice Location Address Fax Number:
206-302-2885
Provider Enumeration Date:
01/31/2011