Provider First Line Business Practice Location Address:
1223 NW 95TH 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:
98117-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-650-5157
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2011