Provider First Line Business Practice Location Address:
4131 15TH 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:
98105-6250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-1575
Provider Business Practice Location Address Fax Number:
206-616-1185
Provider Enumeration Date:
01/31/2007