Provider First Line Business Practice Location Address:
4510 THACKERAY PL 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:
98105-4842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-675-8757
Provider Business Practice Location Address Fax Number:
206-545-9223
Provider Enumeration Date:
12/12/2006