Provider First Line Business Practice Location Address:
6319 24TH 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:
98107-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-7171
Provider Business Practice Location Address Fax Number:
206-781-5079
Provider Enumeration Date:
01/18/2007