Provider First Line Business Practice Location Address:
4842 NE 43RD 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:
98105-5118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-1864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2008