Provider First Line Business Practice Location Address:
1407 NW 70TH 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:
98117-5340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-551-3725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2012