Provider First Line Business Practice Location Address:
8006 15TH AVE NW
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:
98117-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-6377
Provider Business Practice Location Address Fax Number:
206-781-9291
Provider Enumeration Date:
11/02/2005