Provider First Line Business Practice Location Address:
1314 NE 43RD ST
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-5832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-2782
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2008