Provider First Line Business Practice Location Address:
13344 1ST AVE NE
Provider Second Line Business Practice Location Address:
SUITE #204
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-3059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-3773
Provider Business Practice Location Address Fax Number:
206-365-0273
Provider Enumeration Date:
12/09/2006