Provider First Line Business Practice Location Address:
1429 N 45TH 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:
98103-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-781-7714
Provider Business Practice Location Address Fax Number:
206-801-3730
Provider Enumeration Date:
06/30/2011