Provider First Line Business Practice Location Address:
9053 6TH 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:
98117-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-203-1068
Provider Business Practice Location Address Fax Number:
541-747-4722
Provider Enumeration Date:
08/01/2007