Provider First Line Business Practice Location Address:
3800 MONTLAKE BLVD
Provider Second Line Business Practice Location Address:
ROOM 148B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-1552
Provider Business Practice Location Address Fax Number:
206-543-6573
Provider Enumeration Date:
02/28/2013