Provider First Line Business Practice Location Address:
853 NE 68TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-284-6040
Provider Business Practice Location Address Fax Number:
206-284-7943
Provider Enumeration Date:
02/01/2007