Provider First Line Business Practice Location Address:
14030 12TH 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:
98125-3196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-707-9298
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2009