Provider First Line Business Practice Location Address:
9042 6TH 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:
98117-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-719-7622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2006