Provider First Line Business Practice Location Address:
4026 NE 55TH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-325-7732
Provider Business Practice Location Address Fax Number:
206-527-8877
Provider Enumeration Date:
05/08/2008