Provider First Line Business Practice Location Address:
5306 BALLARD AVE NW STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-4366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-522-0269
Provider Business Practice Location Address Fax Number:
206-522-5595
Provider Enumeration Date:
05/17/2007