Provider First Line Business Practice Location Address:
3216 NE 45TH PL
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-4093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-1168
Provider Business Practice Location Address Fax Number:
206-525-1169
Provider Enumeration Date:
06/14/2006