Provider First Line Business Practice Location Address:
11311 14TH AVE NE
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:
98125-6313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-363-1156
Provider Business Practice Location Address Fax Number:
206-362-6059
Provider Enumeration Date:
08/12/2006