Provider First Line Business Practice Location Address:
1702 DEXTER AVE N
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:
98109-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-522-6640
Provider Business Practice Location Address Fax Number:
206-527-0147
Provider Enumeration Date:
04/06/2009