Provider First Line Business Practice Location Address:
8837 WALLINGFORD 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:
98103-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-501-4435
Provider Business Practice Location Address Fax Number:
888-972-1107
Provider Enumeration Date:
09/18/2007