Provider First Line Business Practice Location Address:
4023 LATONA AVE NE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-683-3042
Provider Business Practice Location Address Fax Number:
206-543-3050
Provider Enumeration Date:
04/12/2012