Provider First Line Business Practice Location Address:
10015 LAKE CITY WAY NE UNIT 247
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:
98125-7770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-537-3386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2018