Provider First Line Business Practice Location Address:
8401 5TH AVE NE STE 102
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:
98115-4171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-559-1839
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2010