Provider First Line Business Practice Location Address:
4745 49TH AVE NE
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:
98105-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-310-2277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2008