Provider First Line Business Practice Location Address:
8520 13TH 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:
98117-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-683-8242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2009