Provider First Line Business Practice Location Address:
5355 TALLMAN AVE NW
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-675-1740
Provider Business Practice Location Address Fax Number:
206-675-1043
Provider Enumeration Date:
08/31/2006