Provider First Line Business Practice Location Address:
6514 B PHINNEY AVE N
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:
98103-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-783-9335
Provider Business Practice Location Address Fax Number:
206-783-6315
Provider Enumeration Date:
08/11/2006