Provider First Line Business Practice Location Address:
4556 UNIVERSITY WAY NE
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-4581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-280-8341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2016