Provider First Line Business Practice Location Address:
132 NW 81ST ST
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:
98117-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-0143
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2012