Provider First Line Business Practice Location Address:
10212 5TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-7452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-6428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2009