Provider First Line Business Practice Location Address:
1429 N 45TH 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:
98103-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-632-2873
Provider Business Practice Location Address Fax Number:
206-632-7054
Provider Enumeration Date:
01/08/2008