Provider First Line Business Practice Location Address:
3849 NE 88TH 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:
98115-3736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-9031
Provider Business Practice Location Address Fax Number:
206-525-7388
Provider Enumeration Date:
11/05/2006