Provider First Line Business Practice Location Address:
7211 29TH 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:
98115-5851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-258-4580
Provider Business Practice Location Address Fax Number:
206-258-4581
Provider Enumeration Date:
04/21/2006