Provider First Line Business Practice Location Address:
907 N 130TH 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:
98133-7568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-362-6116
Provider Business Practice Location Address Fax Number:
206-440-8411
Provider Enumeration Date:
12/12/2006