Provider First Line Business Practice Location Address:
4020 NE 55TH 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:
98105-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-528-1980
Provider Business Practice Location Address Fax Number:
206-528-2804
Provider Enumeration Date:
07/18/2012