Provider First Line Business Practice Location Address:
6337 4TH 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:
98115-6513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-522-7840
Provider Business Practice Location Address Fax Number:
206-522-7220
Provider Enumeration Date:
10/31/2005