Provider First Line Business Practice Location Address:
3540 NE 110TH 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:
98125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-367-1004
Provider Business Practice Location Address Fax Number:
206-363-1876
Provider Enumeration Date:
10/13/2010