Provider First Line Business Practice Location Address:
3601 FREMONT AVE N
Provider Second Line Business Practice Location Address:
SUITE 412
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-853-1540
Provider Business Practice Location Address Fax Number:
206-260-7900
Provider Enumeration Date:
12/27/2016