Provider First Line Business Practice Location Address:
6748 EARL AVE NW
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:
98117-5929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-331-2649
Provider Business Practice Location Address Fax Number:
206-326-3659
Provider Enumeration Date:
10/26/2009