Provider First Line Business Practice Location Address:
10241 GREENWOOD 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:
98133-9141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-4035
Provider Business Practice Location Address Fax Number:
206-789-3541
Provider Enumeration Date:
08/21/2006