Provider First Line Business Practice Location Address:
1123 NW 65TH ST
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:
98117-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-491-6195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2008