Provider First Line Business Practice Location Address:
4360 LEARY WAY NW
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-4554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-653-7378
Provider Business Practice Location Address Fax Number:
253-653-7378
Provider Enumeration Date:
04/10/2007