Provider First Line Business Practice Location Address:
4701 MIDVALE 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:
98103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-547-5647
Provider Business Practice Location Address Fax Number:
206-545-9291
Provider Enumeration Date:
10/03/2006