Provider First Line Business Practice Location Address:
2124 N 62ND 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:
98103-5721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-522-7787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007