Provider First Line Business Practice Location Address:
3809 42ND AVE S
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:
98118-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-788-6777
Provider Business Practice Location Address Fax Number:
206-299-2822
Provider Enumeration Date:
01/19/2010