Provider First Line Business Practice Location Address:
1045 NE 103RD 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:
98125-7521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-947-4153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2006