Provider First Line Business Practice Location Address:
7109 GREENWOOD AVE N
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:
98103-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-782-8370
Provider Business Practice Location Address Fax Number:
206-783-2865
Provider Enumeration Date:
05/17/2007