Provider First Line Business Practice Location Address:
8023 12TH 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:
98117-4126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-612-8571
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2012