Provider First Line Business Practice Location Address:
3135 NE 85TH ST
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:
98115-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-718-4170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2007