Provider First Line Business Practice Location Address:
14300 GREENWOOD AVE N
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-6831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-777-1190
Provider Business Practice Location Address Fax Number:
206-420-3835
Provider Enumeration Date:
09/25/2012