Provider First Line Business Practice Location Address:
9635 17TH AVE SW
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:
98106-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-763-5057
Provider Business Practice Location Address Fax Number:
206-763-5241
Provider Enumeration Date:
06/15/2006