Provider First Line Business Practice Location Address:
6239 WOODLAWN AVE N
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:
98103-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-271-4796
Provider Business Practice Location Address Fax Number:
206-729-2660
Provider Enumeration Date:
02/19/2016