Provider First Line Business Practice Location Address:
3290 NE 65TH STREET
Provider Second Line Business Practice Location Address:
UNIT 101
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-388-2549
Provider Business Practice Location Address Fax Number:
206-829-4352
Provider Enumeration Date:
09/06/2016