Provider First Line Business Practice Location Address:
10317 GREENWOOD AVE N UNIT 102
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:
206-784-2422
Provider Business Practice Location Address Fax Number:
206-782-1311
Provider Enumeration Date:
01/24/2007