Provider First Line Business Practice Location Address:
4227 4TH AVE NW
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:
98107-5013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-419-5427
Provider Business Practice Location Address Fax Number:
206-905-2999
Provider Enumeration Date:
12/17/2008