Provider First Line Business Practice Location Address:
14500 GREENWOOD AVE N
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-6419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-1900
Provider Business Practice Location Address Fax Number:
206-440-0478
Provider Enumeration Date:
03/28/2007