Provider First Line Business Practice Location Address:
1846 N 53RD 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:
98103-6116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-8440
Provider Business Practice Location Address Fax Number:
206-547-0650
Provider Enumeration Date:
02/13/2009