Provider First Line Business Practice Location Address:
7812 LAKE CITY WAY 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:
98115-4358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-334-5416
Provider Business Practice Location Address Fax Number:
206-774-8420
Provider Enumeration Date:
12/07/2006