Provider First Line Business Practice Location Address:
2271 NE 51ST STREET
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:
98105-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-522-8553
Provider Business Practice Location Address Fax Number:
206-522-7815
Provider Enumeration Date:
06/20/2006