Provider First Line Business Practice Location Address:
9602 FREMONT AVE N
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:
98103-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-620-1628
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2006