Provider First Line Business Practice Location Address:
10215 LAKE CITY WAY NE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-7757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-2612
Provider Business Practice Location Address Fax Number:
206-525-0818
Provider Enumeration Date:
05/05/2010