Provider First Line Business Practice Location Address:
10616 16TH AVE SW
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:
98146-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-243-4433
Provider Business Practice Location Address Fax Number:
206-243-5188
Provider Enumeration Date:
10/26/2007