Provider First Line Business Practice Location Address:
4411 FREMONT AVE N
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:
98103-7225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-683-4495
Provider Business Practice Location Address Fax Number:
888-519-9390
Provider Enumeration Date:
04/25/2016