Provider First Line Business Practice Location Address:
1015 NE 113TH 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:
98125-6454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-9601
Provider Business Practice Location Address Fax Number:
206-363-9639
Provider Enumeration Date:
02/05/2007