Provider First Line Business Practice Location Address:
157 NW 77TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-633-2384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006