Provider First Line Business Practice Location Address:
9706 4TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-517-7697
Provider Business Practice Location Address Fax Number:
206-729-7078
Provider Enumeration Date:
11/01/2006