Provider First Line Business Practice Location Address:
6701 GREENWOOD AVE N
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:
98103-5225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-357-3008
Provider Business Practice Location Address Fax Number:
206-834-6006
Provider Enumeration Date:
01/29/2020