Provider First Line Business Practice Location Address:
11745 9TH 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:
98125-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-799-1052
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2008