Provider First Line Business Practice Location Address:
823 NE 65TH 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:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-2183
Provider Business Practice Location Address Fax Number:
206-729-6313
Provider Enumeration Date:
01/09/2007