Provider First Line Business Practice Location Address:
7311 15TH 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:
98117-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-783-1828
Provider Business Practice Location Address Fax Number:
206-783-1822
Provider Enumeration Date:
02/25/2009