Provider First Line Business Practice Location Address:
11304 8TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-6111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-6184
Provider Business Practice Location Address Fax Number:
206-363-6543
Provider Enumeration Date:
11/15/2006