Provider First Line Business Practice Location Address:
5370 WILSON AVE S
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:
98118-2566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-3791
Provider Business Practice Location Address Fax Number:
206-723-1506
Provider Enumeration Date:
01/04/2007