Provider First Line Business Practice Location Address:
13717 GREENWOOD AVE N
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-6875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-918-3069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2011