Provider First Line Business Practice Location Address:
1512 NE 70TH ST
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:
98115-5745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-320-6772
Provider Business Practice Location Address Fax Number:
425-526-5659
Provider Enumeration Date:
07/29/2014