Provider First Line Business Practice Location Address:
1600 DEXTER AVE N
Provider Second Line Business Practice Location Address:
SUITE C-4
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-3079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-406-4410
Provider Business Practice Location Address Fax Number:
206-283-0851
Provider Enumeration Date:
01/22/2007