Provider First Line Business Practice Location Address:
6515 12TH 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:
98115-6753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-605-0433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2007