Provider First Line Business Practice Location Address:
5409 15TH 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:
98107-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-781-0056
Provider Business Practice Location Address Fax Number:
206-781-1922
Provider Enumeration Date:
11/08/2011