Provider First Line Business Practice Location Address:
4721 47TH AVE NE
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:
98105-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-0361
Provider Business Practice Location Address Fax Number:
206-526-0369
Provider Enumeration Date:
01/09/2007