Provider First Line Business Practice Location Address:
2315 NE 65TH 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:
98115-7069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-7315
Provider Business Practice Location Address Fax Number:
206-729-4972
Provider Enumeration Date:
04/13/2011