Provider First Line Business Practice Location Address:
10740 MERIDIAN AVE N
Provider Second Line Business Practice Location Address:
G-3
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-9010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-5177
Provider Business Practice Location Address Fax Number:
206-362-0943
Provider Enumeration Date:
05/29/2007