Provider First Line Business Practice Location Address:
3417 EVANSTON AVE N
Provider Second Line Business Practice Location Address:
SUITE 229
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-8626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-858-2914
Provider Business Practice Location Address Fax Number:
206-732-6544
Provider Enumeration Date:
08/15/2006