Provider First Line Business Practice Location Address:
1762 NW 56TH 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:
98107-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-402-3781
Provider Business Practice Location Address Fax Number:
206-588-2046
Provider Enumeration Date:
12/03/2009