Provider First Line Business Practice Location Address:
1536 N 115TH ST. SUITE 100
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:
98133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-1765
Provider Business Practice Location Address Fax Number:
206-368-1128
Provider Enumeration Date:
11/09/2017