Provider First Line Business Practice Location Address:
1225 NE 105TH 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:
98125-7530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-925-3158
Provider Business Practice Location Address Fax Number:
206-338-6379
Provider Enumeration Date:
04/20/2006