Provider First Line Business Practice Location Address:
3812 NE 55TH 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:
98105-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-395-6585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2007