Provider First Line Business Practice Location Address:
3316 NE 125TH ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-4487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2011