Provider First Line Business Practice Location Address:
5107 PHINNEY AVE N
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:
98103-6028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-923-0008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2007