Provider First Line Business Practice Location Address:
9201 15TH 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:
98117-2336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-1207
Provider Business Practice Location Address Fax Number:
206-252-1201
Provider Enumeration Date:
12/05/2012