Provider First Line Business Practice Location Address:
2319 N 45TH ST
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98103-6982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-388-5881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2007