Provider First Line Business Practice Location Address:
1205 NE 50TH 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:
98105-4406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-204-0145
Provider Business Practice Location Address Fax Number:
206-204-0176
Provider Enumeration Date:
01/12/2010