Provider First Line Business Practice Location Address:
6329 15TH 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:
98115-6803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-364-7126
Provider Business Practice Location Address Fax Number:
206-522-1997
Provider Enumeration Date:
03/01/2007