Provider First Line Business Practice Location Address:
12520 26TH AVE NE
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-628-5738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2013