Provider First Line Business Practice Location Address:
7701 23RD AVE NW
Provider Second Line Business Practice Location Address:
4511 WALLINGFORD AVE N
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98117-4318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-782-1805
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2007