Provider First Line Business Practice Location Address:
5511 15TH 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:
98108-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-252-7807
Provider Business Practice Location Address Fax Number:
206-252-7801
Provider Enumeration Date:
11/30/2012