Provider First Line Business Practice Location Address:
9015 HOLMAN RD NW
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98117-3481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-8119
Provider Business Practice Location Address Fax Number:
206-784-4020
Provider Enumeration Date:
06/18/2012