Provider First Line Business Practice Location Address:
6532 PHINNEY AVE N.
Provider Second Line Business Practice Location Address:
ROOM 30
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-226-7943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2015