Provider First Line Business Practice Location Address:
3819 NE 45TH STREET
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:
98105-5144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-6116
Provider Business Practice Location Address Fax Number:
206-528-0406
Provider Enumeration Date:
12/22/2006