Provider First Line Business Practice Location Address:
5044 38TH 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:
98105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-528-5692
Provider Business Practice Location Address Fax Number:
206-528-0044
Provider Enumeration Date:
06/26/2007