Provider First Line Business Practice Location Address:
4428 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:
206-633-4941
Provider Business Practice Location Address Fax Number:
206-367-0612
Provider Enumeration Date:
10/30/2007