Provider First Line Business Practice Location Address:
4526 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:
98105-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-8094
Provider Business Practice Location Address Fax Number:
206-522-4634
Provider Enumeration Date:
10/16/2006