Provider First Line Business Practice Location Address:
12330 22ND 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:
98125-5208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-430-5148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2010