Provider First Line Business Practice Location Address:
402 NE 72ND ST
Provider Second Line Business Practice Location Address:
#8
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-5456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-962-1568
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2010