Provider First Line Business Practice Location Address:
5401 LEARY AVE NW
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:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-582-3471
Provider Business Practice Location Address Fax Number:
206-582-3472
Provider Enumeration Date:
10/27/2016