Provider First Line Business Practice Location Address:
621 S WELLER ST
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:
98104-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-359-0247
Provider Business Practice Location Address Fax Number:
206-748-5168
Provider Enumeration Date:
12/18/2009