Provider First Line Business Practice Location Address:
5719 29TH AVE NE
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:
98105-5521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-909-7962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010