Provider First Line Business Practice Location Address:
3540 NE 110TH 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:
98125-5761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-7733
Provider Business Practice Location Address Fax Number:
206-363-1876
Provider Enumeration Date:
10/07/2005