Provider First Line Business Practice Location Address:
1822 NE 96TH ST
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:
98115-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-661-0832
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2013