Provider First Line Business Practice Location Address:
12567 DENSMORE AVE N
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:
98133-7730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-369-7833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2008