Provider First Line Business Practice Location Address:
411B NW 101ST 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:
98177-4936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-774-5938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2008