Provider First Line Business Practice Location Address:
916 N 82ND ST
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:
98103-4322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-428-1964
Provider Business Practice Location Address Fax Number:
206-706-9349
Provider Enumeration Date:
01/07/2009