Provider First Line Business Practice Location Address:
2611 NE 125TH ST
Provider Second Line Business Practice Location Address:
247
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-5090
Provider Business Practice Location Address Fax Number:
206-367-8634
Provider Enumeration Date:
02/01/2006