Provider First Line Business Practice Location Address:
3409 NE 57TH STREET
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:
98105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-617-1190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2005