Provider First Line Business Practice Location Address:
13344 1ST AVE NE
Provider Second Line Business Practice Location Address:
SUITE 205
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:
206-364-7575
Provider Business Practice Location Address Fax Number:
206-364-7589
Provider Enumeration Date:
08/13/2006