Provider First Line Business Practice Location Address:
4131 1ST 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:
98107-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-633-2405
Provider Business Practice Location Address Fax Number:
206-547-5298
Provider Enumeration Date:
01/12/2012