Provider First Line Business Practice Location Address:
4741 UNIVERSITY WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-9454
Provider Business Practice Location Address Fax Number:
206-522-5138
Provider Enumeration Date:
05/14/2007