Provider First Line Business Practice Location Address:
5401 LEARY AVE NW STE 203
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:
98107-4070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-582-3471
Provider Business Practice Location Address Fax Number:
206-582-3472
Provider Enumeration Date:
10/30/2018