Provider First Line Business Practice Location Address:
12610 DES MOINES MEM DR S
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98168-2284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-243-7818
Provider Business Practice Location Address Fax Number:
206-243-0419
Provider Enumeration Date:
12/07/2007