Provider First Line Business Practice Location Address:
2152 N 122ND 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:
98133-8524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-4105
Provider Business Practice Location Address Fax Number:
206-363-1723
Provider Enumeration Date:
12/18/2014