Provider First Line Business Practice Location Address:
6515 12TH AVE NE
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:
98115-6753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-524-5511
Provider Business Practice Location Address Fax Number:
206-829-8415
Provider Enumeration Date:
04/18/2007