Provider First Line Business Practice Location Address:
2150 N 107TH ST
Provider Second Line Business Practice Location Address:
SUITE 345, NORTHWAY EAST BUILDING
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-364-6565
Provider Business Practice Location Address Fax Number:
206-364-6566
Provider Enumeration Date:
04/23/2007