Provider First Line Business Practice Location Address:
8044 35TH AVE NORTH EAST
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:
98115-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-6636
Provider Business Practice Location Address Fax Number:
206-525-4469
Provider Enumeration Date:
09/20/2006