Provider First Line Business Practice Location Address:
5606 14TH AVE NW
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:
98107-3715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-782-4484
Provider Business Practice Location Address Fax Number:
206-782-4982
Provider Enumeration Date:
10/23/2006