Provider First Line Business Practice Location Address:
714 N 72ND 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:
98103-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-239-8175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2010