Provider First Line Business Practice Location Address:
5401 LEARY AVE NW
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:
98107-4070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-623-0373
Provider Business Practice Location Address Fax Number:
206-838-3678
Provider Enumeration Date:
07/07/2009