Provider First Line Business Practice Location Address:
322 NW 103RD 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:
98177-4938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-1764
Provider Business Practice Location Address Fax Number:
206-781-5923
Provider Enumeration Date:
06/22/2010