Provider First Line Business Practice Location Address:
526 YALE AVE N
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:
98109-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-403-0190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2007