Provider First Line Business Practice Location Address:
3216 NE 45TH PL
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-4093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-526-0210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2005