Provider First Line Business Practice Location Address:
2130 WESTLAKE AVE N
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-2495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-838-5318
Provider Business Practice Location Address Fax Number:
206-432-8876
Provider Enumeration Date:
02/16/2010