Provider First Line Business Practice Location Address:
5803 15TH AVE NW
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:
98107-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-3740
Provider Business Practice Location Address Fax Number:
206-784-9869
Provider Enumeration Date:
01/03/2006