Provider First Line Business Practice Location Address:
111 NE 80TH 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:
98115-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-517-0403
Provider Business Practice Location Address Fax Number:
206-523-7488
Provider Enumeration Date:
02/29/2008