Provider First Line Business Practice Location Address:
6327 21ST AVENUE 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:
206-523-7538
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006