Provider First Line Business Practice Location Address:
859 NE NORTHGATE WAY
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:
98125-7311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-417-0520
Provider Business Practice Location Address Fax Number:
206-417-0559
Provider Enumeration Date:
01/19/2019