Provider First Line Business Practice Location Address:
10215 LAKE CITY WAY NE STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-7758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-816-4414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2020