Provider First Line Business Practice Location Address:
4428 52ND PL 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:
98116-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-755-2042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2011