Provider First Line Business Practice Location Address:
4511 DENSMORE AVE N
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-6783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-522-0207
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2007