Provider First Line Business Practice Location Address:
8250 LATONA AVE NE
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:
98115-4055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-528-2954
Provider Business Practice Location Address Fax Number:
206-522-4749
Provider Enumeration Date:
06/01/2007