Provider First Line Business Practice Location Address:
12000 15TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-409-9447
Provider Business Practice Location Address Fax Number:
360-297-0420
Provider Enumeration Date:
05/19/2006