Provider First Line Business Practice Location Address:
1107 NE 45TH
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-819-6280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2010