Provider First Line Business Practice Location Address:
10417 23RD AVE 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:
98125-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-729-8263
Provider Business Practice Location Address Fax Number:
206-522-5640
Provider Enumeration Date:
09/27/2008