Provider First Line Business Practice Location Address:
7715 24TH 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:
98117-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-782-1133
Provider Business Practice Location Address Fax Number:
206-782-1373
Provider Enumeration Date:
11/14/2005