Provider First Line Business Practice Location Address:
1900 N NORTHLAKE WAY
Provider Second Line Business Practice Location Address:
SUITE 127
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-9051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-1382
Provider Business Practice Location Address Fax Number:
206-525-1382
Provider Enumeration Date:
01/16/2007