Provider First Line Business Practice Location Address:
1718 NW 56TH ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-5237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-706-2533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2013