Provider First Line Business Practice Location Address:
9250 45TH AVE SW
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:
98136-2633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-412-3586
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006