Provider First Line Business Practice Location Address:
13319 1ST 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:
98125-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-3121
Provider Business Practice Location Address Fax Number:
206-365-0253
Provider Enumeration Date:
11/28/2009