Provider First Line Business Practice Location Address:
6524 28TH AVE NW
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:
98117-5905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-8460
Provider Business Practice Location Address Fax Number:
206-789-2853
Provider Enumeration Date:
04/14/2010