Provider First Line Business Practice Location Address:
1712 NE 86TH 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:
98115-3242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-778-1045
Provider Business Practice Location Address Fax Number:
206-453-5563
Provider Enumeration Date:
06/10/2014