Provider First Line Business Practice Location Address:
3327 NE 125TH ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-362-8314
Provider Business Practice Location Address Fax Number:
206-362-3028
Provider Enumeration Date:
04/20/2007