Provider First Line Business Practice Location Address:
1208 24TH AVE E
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:
98112-3626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-948-8273
Provider Business Practice Location Address Fax Number:
253-288-2203
Provider Enumeration Date:
01/31/2008