Provider First Line Business Practice Location Address:
506 NE 65TH 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:
98115-6412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-3127
Provider Business Practice Location Address Fax Number:
206-547-8525
Provider Enumeration Date:
12/06/2012