Provider First Line Business Practice Location Address:
4715 42ND AVE SW
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:
98116-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-265-3642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2010