Provider First Line Business Practice Location Address:
6739 15TH AVE NW
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:
98117-5508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-985-6619
Provider Business Practice Location Address Fax Number:
206-577-3599
Provider Enumeration Date:
01/23/2013