Provider First Line Business Practice Location Address:
12733 28TH 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:
98125-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-366-9543
Provider Business Practice Location Address Fax Number:
206-366-9544
Provider Enumeration Date:
07/19/2005