Provider First Line Business Practice Location Address:
1107 NE 45TH ST
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-4690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-250-0642
Provider Business Practice Location Address Fax Number:
206-632-7173
Provider Enumeration Date:
08/31/2006