Provider First Line Business Practice Location Address:
6815 20TH 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:
98115-6945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-251-5611
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007