Provider First Line Business Practice Location Address:
2811 NW 62ND 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:
98107-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-529-4598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2009