Provider First Line Business Practice Location Address:
6800 E GREEN LAKE WAY N
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-5489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-5656
Provider Business Practice Location Address Fax Number:
206-524-2841
Provider Enumeration Date:
05/23/2011