Provider First Line Business Practice Location Address:
6748 1ST AVE NW
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:
98117-4827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-462-9166
Provider Business Practice Location Address Fax Number:
206-297-7555
Provider Enumeration Date:
03/01/2017