Provider First Line Business Practice Location Address:
7602 6TH AVE NE
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:
98115-4130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-527-8773
Provider Business Practice Location Address Fax Number:
206-517-4224
Provider Enumeration Date:
12/28/2006