Provider First Line Business Practice Location Address:
140 LAKESIDE AVE STE A-61
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:
98122-6551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-455-8972
Provider Business Practice Location Address Fax Number:
877-418-7475
Provider Enumeration Date:
12/21/2010