Provider First Line Business Practice Location Address:
12345 LAKE CITY WAY NE STE 117
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:
98125-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-335-2892
Provider Business Practice Location Address Fax Number:
206-629-7660
Provider Enumeration Date:
07/11/2006