Provider First Line Business Practice Location Address:
2116 N 42ND 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:
98103-7610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-545-4181
Provider Business Practice Location Address Fax Number:
206-632-5761
Provider Enumeration Date:
06/30/2006