Provider First Line Business Practice Location Address:
909 NE 45TH 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:
98105-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-7180
Provider Business Practice Location Address Fax Number:
206-523-0323
Provider Enumeration Date:
03/18/2013