Provider First Line Business Practice Location Address:
11046 GREENWOOD AVENUE NORTH
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-440-0925
Provider Business Practice Location Address Fax Number:
206-440-0925
Provider Enumeration Date:
12/08/2006