Provider First Line Business Practice Location Address:
1929 QUEEN 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:
98109-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-285-1737
Provider Business Practice Location Address Fax Number:
206-285-1791
Provider Enumeration Date:
10/28/2017