Provider First Line Business Practice Location Address:
13752 28TH AVE NE
Provider Second Line Business Practice Location Address:
#5
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-295-6258
Provider Business Practice Location Address Fax Number:
206-362-3835
Provider Enumeration Date:
02/18/2015