Provider First Line Business Practice Location Address:
2530 15TH AVE W STE A
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:
98119-2188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-283-0964
Provider Business Practice Location Address Fax Number:
206-283-0965
Provider Enumeration Date:
08/21/2009