Provider First Line Business Practice Location Address:
504 NE 95TH 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:
98115-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-5500
Provider Business Practice Location Address Fax Number:
206-743-3157
Provider Enumeration Date:
12/12/2012