Provider First Line Business Practice Location Address:
1620 43RD AVE E
Provider Second Line Business Practice Location Address:
#4B
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-618-7729
Provider Business Practice Location Address Fax Number:
206-325-0366
Provider Enumeration Date:
11/27/2006