Provider First Line Business Practice Location Address:
413 FAIRVIEW AVE N
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:
98109-5316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-275-4334
Provider Business Practice Location Address Fax Number:
206-623-5562
Provider Enumeration Date:
05/29/2012