Provider First Line Business Practice Location Address:
5000 30TH AVENUE N.E.
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-322-1880
Provider Business Practice Location Address Fax Number:
206-729-0436
Provider Enumeration Date:
12/28/2006