Provider First Line Business Practice Location Address:
4459 FREMONT AVE N
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:
98103-7293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-419-8516
Provider Business Practice Location Address Fax Number:
206-315-5398
Provider Enumeration Date:
01/20/2010