Provider First Line Business Practice Location Address:
9045 16TH AVE SW
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:
98106-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-762-7207
Provider Business Practice Location Address Fax Number:
206-762-7980
Provider Enumeration Date:
09/19/2008