Provider First Line Business Practice Location Address:
4706 42ND 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:
98116-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-932-8045
Provider Business Practice Location Address Fax Number:
206-932-3094
Provider Enumeration Date:
08/30/2006