Provider First Line Business Practice Location Address:
1410 NE 66TH ST
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:
98115-6744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-527-8336
Provider Business Practice Location Address Fax Number:
206-517-4195
Provider Enumeration Date:
11/05/2012