Provider First Line Business Practice Location Address:
7728 12TH AVE NW
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:
98117-4135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-227-5350
Provider Business Practice Location Address Fax Number:
206-866-1235
Provider Enumeration Date:
12/27/2006