Provider First Line Business Practice Location Address:
13224 4TH AVE NW
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:
98177-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-992-3880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2006