Provider First Line Business Practice Location Address:
1434A NW 59TH 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:
98107-2945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-427-6164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2010