Provider First Line Business Practice Location Address:
6307 19TH 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:
98115-6903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-1571
Provider Business Practice Location Address Fax Number:
206-523-3810
Provider Enumeration Date:
12/26/2006