Provider First Line Business Practice Location Address:
13000 LAKE CITY WAY NE
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:
98125-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-440-2433
Provider Business Practice Location Address Fax Number:
206-440-2427
Provider Enumeration Date:
01/17/2015