Provider First Line Business Practice Location Address:
7556 15TH 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:
98117-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-5372
Provider Business Practice Location Address Fax Number:
206-784-6389
Provider Enumeration Date:
03/01/2007