Provider First Line Business Practice Location Address:
1545 NW 57TH ST
Provider Second Line Business Practice Location Address:
427
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-5644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-7145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007