Provider First Line Business Practice Location Address:
4426 BURKE 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:
98103-7536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-2030
Provider Business Practice Location Address Fax Number:
206-632-2747
Provider Enumeration Date:
11/02/2007