Provider First Line Business Practice Location Address:
2312 N 59TH 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:
98103-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-491-4565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2008