Provider First Line Business Practice Location Address:
1959 NE PACIFIC STREET HEALTH SCIENCE CENTER ROOM B-403
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-5797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2020