Provider First Line Business Practice Location Address:
4328 BAKER AVE NW
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:
98107-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-829-1899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2020