Provider First Line Business Practice Location Address:
9620 28TH 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:
98126-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-923-9110
Provider Business Practice Location Address Fax Number:
206-935-7506
Provider Enumeration Date:
07/02/2006