Provider First Line Business Practice Location Address:
919 NW 122ND ST
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:
98177-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-797-2102
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006