Provider First Line Business Practice Location Address:
106 LAKESIDE AVE
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:
98122-6542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-465-5650
Provider Business Practice Location Address Fax Number:
206-257-5562
Provider Enumeration Date:
02/26/2007