Provider First Line Business Practice Location Address:
7031- 27TH AVE. N.E.
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:
98115-5843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-6429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2009