Provider First Line Business Practice Location Address:
4411 FREMONT AVE N
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:
98103-7225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-957-1881
Provider Business Practice Location Address Fax Number:
206-957-1895
Provider Enumeration Date:
10/17/2006