Provider First Line Business Practice Location Address:
3601 FREMONT AVE N
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-548-1522
Provider Business Practice Location Address Fax Number:
425-746-2471
Provider Enumeration Date:
05/29/2014