Provider First Line Business Practice Location Address:
116 FAIRVIEW AVE N
Provider Second Line Business Practice Location Address:
SUITE 148
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-682-7942
Provider Business Practice Location Address Fax Number:
206-701-7965
Provider Enumeration Date:
12/19/2011