Provider First Line Business Practice Location Address:
208 NW 45TH 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:
98107-4336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-227-0165
Provider Business Practice Location Address Fax Number:
206-685-4184
Provider Enumeration Date:
12/28/2011