Provider First Line Business Practice Location Address:
10317 GREENWOOD AVENUE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-9152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-297-6056
Provider Business Practice Location Address Fax Number:
206-297-6059
Provider Enumeration Date:
11/07/2006