Provider First Line Business Practice Location Address:
6707 35TH PL S
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:
98118-6454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-552-0312
Provider Business Practice Location Address Fax Number:
206-338-9960
Provider Enumeration Date:
08/08/2006