Provider First Line Business Practice Location Address:
6300 9TH AVE NE STE 106
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:
98115-8516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-718-1455
Provider Business Practice Location Address Fax Number:
206-524-5054
Provider Enumeration Date:
01/31/2010