Provider First Line Business Practice Location Address:
4464 FREMONT AVE N STE 102
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:
98103-7290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-817-5896
Provider Business Practice Location Address Fax Number:
206-326-1398
Provider Enumeration Date:
01/12/2007