Provider First Line Business Practice Location Address:
5414 BARNES 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:
98107-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-787-0641
Provider Business Practice Location Address Fax Number:
206-784-4386
Provider Enumeration Date:
05/29/2006