Provider First Line Business Practice Location Address:
4026 NE 55TH ST
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-9195
Provider Business Practice Location Address Fax Number:
206-523-5399
Provider Enumeration Date:
06/08/2005