Provider First Line Business Practice Location Address:
7813 12TH 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:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-9346
Provider Business Practice Location Address Fax Number:
206-524-6657
Provider Enumeration Date:
05/01/2007