Provider First Line Business Practice Location Address:
18532 FIRLANDS WAY NORTH
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-3986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-542-7516
Provider Business Practice Location Address Fax Number:
206-542-7517
Provider Enumeration Date:
01/24/2007