Provider First Line Business Practice Location Address:
1417 NW 54TH ST STE 402
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:
98107-3576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-257-7122
Provider Business Practice Location Address Fax Number:
206-257-7122
Provider Enumeration Date:
10/05/2007