Provider First Line Business Practice Location Address:
4744 41ST AVE SW
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:
98116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-932-0880
Provider Business Practice Location Address Fax Number:
206-932-3738
Provider Enumeration Date:
03/03/2006