Provider First Line Business Practice Location Address:
1542 NW 63RD ST
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:
98107-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-7762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2012