Provider First Line Business Practice Location Address:
4131 15TH AVE. NE
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:
98105-6299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-5440
Provider Business Practice Location Address Fax Number:
206-616-1185
Provider Enumeration Date:
04/12/2010