Provider First Line Business Practice Location Address:
2211 N 56TH 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:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-1313
Provider Business Practice Location Address Fax Number:
206-545-7971
Provider Enumeration Date:
01/30/2008