Provider First Line Business Practice Location Address:
4026 NE 55TH STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-3690
Provider Business Practice Location Address Fax Number:
206-368-9390
Provider Enumeration Date:
02/02/2006