Provider First Line Business Practice Location Address:
14419 GREENWOOD AVE N
Provider Second Line Business Practice Location Address:
A175
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-6865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-250-6254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2007