Provider First Line Business Practice Location Address:
1530 N 115TH ST
Provider Second Line Business Practice Location Address:
#112
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-2255
Provider Business Practice Location Address Fax Number:
206-368-1128
Provider Enumeration Date:
08/10/2005