Provider First Line Business Practice Location Address:
1714 N 128TH ST
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:
98133-7727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-364-6297
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007