Provider First Line Business Practice Location Address:
4444 WOODLAND PARK AVE N
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-7429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-310-2823
Provider Business Practice Location Address Fax Number:
206-547-5883
Provider Enumeration Date:
11/02/2007