Provider First Line Business Practice Location Address:
515 MINOR AVE STE 120B
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:
98104-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-622-2430
Provider Business Practice Location Address Fax Number:
206-622-3667
Provider Enumeration Date:
01/19/2016