Provider First Line Business Practice Location Address:
320 N 110TH 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:
98133-8734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-992-7485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2010