Provider First Line Business Practice Location Address:
3418 NE 65TH 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:
98115-7341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-235-9393
Provider Business Practice Location Address Fax Number:
206-517-8123
Provider Enumeration Date:
10/16/2006