Provider First Line Business Practice Location Address:
7009 17TH 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:
98117-5551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-465-1052
Provider Business Practice Location Address Fax Number:
206-386-3195
Provider Enumeration Date:
09/30/2008