Provider First Line Business Practice Location Address:
13346 1ST AVE NE
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:
98125-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-236-1260
Provider Business Practice Location Address Fax Number:
206-361-2605
Provider Enumeration Date:
03/23/2007