Provider First Line Business Practice Location Address:
3513 NE 45TH ST
Provider Second Line Business Practice Location Address:
SUITE 2W
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-5660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-3820
Provider Business Practice Location Address Fax Number:
206-523-1645
Provider Enumeration Date:
01/04/2007