Provider First Line Business Practice Location Address:
3914 MIDVALE 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:
98103-7925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-4244
Provider Business Practice Location Address Fax Number:
206-632-4344
Provider Enumeration Date:
05/23/2007