Provider First Line Business Practice Location Address:
8010 15TH AVE NW
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-268-0397
Provider Business Practice Location Address Fax Number:
206-518-9225
Provider Enumeration Date:
10/31/2017