Provider First Line Business Practice Location Address:
1531 NE 145TH 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:
98155-7205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-366-4672
Provider Business Practice Location Address Fax Number:
206-366-4674
Provider Enumeration Date:
03/08/2006