Provider First Line Business Practice Location Address:
5325 BALLARD AVE NW
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-747-2965
Provider Business Practice Location Address Fax Number:
206-902-9890
Provider Enumeration Date:
02/15/2007