Provider's Name:

Partner or Resident Manager:

AFH License #:

Address:

Address 2:

City:

State:

Zip:

Area:

Phone:

Phone 2:

Cell Phone:

Phone 3:

800 number:

Fax:

Fax Need To Call First:

Email:

Alternate email:

Web Address:

Our Location:

1808 NE Perkins Way
Shoreline, WA 98155