Provider First Line Business Practice Location Address:
9115 45TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-573-7414
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2013