Provider First Line Business Practice Location Address:
3316 NE 125TH ST STE 2
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:
98125-4565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-203-2509
Provider Business Practice Location Address Fax Number:
855-897-3364
Provider Enumeration Date:
08/29/2010