Provider First Line Business Practice Location Address:
1733 N 128TH 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:
98133-7726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-5720
Provider Business Practice Location Address Fax Number:
206-367-9012
Provider Enumeration Date:
10/05/2005