Provider First Line Business Practice Location Address:
5618 4TH 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:
98107-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-930-7553
Provider Business Practice Location Address Fax Number:
509-352-9413
Provider Enumeration Date:
08/26/2008