Provider First Line Business Practice Location Address:
4464 FREMONT AVE N
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-7273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-779-9302
Provider Business Practice Location Address Fax Number:
206-522-0531
Provider Enumeration Date:
01/02/2007