Provider First Line Business Practice Location Address:
3718 48TH AVE NE
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:
98105-5250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-5008
Provider Business Practice Location Address Fax Number:
206-524-5008
Provider Enumeration Date:
02/21/2007