Provider First Line Business Practice Location Address:
6534 4TH 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:
98115-6440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-783-6505
Provider Business Practice Location Address Fax Number:
253-382-2091
Provider Enumeration Date:
12/04/2006