Provider First Line Business Practice Location Address:
201 YALE AVE N
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:
98109-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-596-2099
Provider Business Practice Location Address Fax Number:
206-636-1015
Provider Enumeration Date:
08/27/2012