Provider First Line Business Practice Location Address:
1003 NE 72ND 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:
98115-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-526-1463
Provider Business Practice Location Address Fax Number:
206-686-7688
Provider Enumeration Date:
12/08/2007