Provider First Line Business Practice Location Address:
3936 WOODLAWN 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:
98103-8207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-5710
Provider Business Practice Location Address Fax Number:
206-632-1020
Provider Enumeration Date:
01/18/2007