Provider First Line Business Practice Location Address:
5410B BARNES 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:
98107-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-782-9530
Provider Business Practice Location Address Fax Number:
206-782-0184
Provider Enumeration Date:
11/21/2006