Provider First Line Business Practice Location Address:
8320 5TH AVE NE STE A
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:
98115-4174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-650-8653
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2019