Provider First Line Business Practice Location Address:
7409 GREENWOOD AVE N
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-297-1126
Provider Business Practice Location Address Fax Number:
206-420-4476
Provider Enumeration Date:
11/18/2012