Provider First Line Business Practice Location Address:
8026 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:
98117-3661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-7707
Provider Business Practice Location Address Fax Number:
206-533-1652
Provider Enumeration Date:
01/29/2008