Provider First Line Business Practice Location Address:
1530 N 115TH ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-6560
Provider Business Practice Location Address Fax Number:
206-368-6562
Provider Enumeration Date:
08/29/2006