Provider First Line Business Practice Location Address:
8915 14TH AVE S
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:
98108-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-762-0876
Provider Business Practice Location Address Fax Number:
206-763-1856
Provider Enumeration Date:
02/22/2007