Provider First Line Business Practice Location Address:
3650 WALLINGFORD 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:
98103-8242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-634-2022
Provider Business Practice Location Address Fax Number:
206-634-9460
Provider Enumeration Date:
01/18/2007