Provider First Line Business Practice Location Address:
4545 41ST AVE SW
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:
98116-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-932-8363
Provider Business Practice Location Address Fax Number:
206-932-4973
Provider Enumeration Date:
06/23/2011