Provider First Line Business Practice Location Address:
5355 TALLMAN AVE NW STE 208
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:
98107-3954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-799-8387
Provider Business Practice Location Address Fax Number:
206-770-6279
Provider Enumeration Date:
01/12/2011