Provider First Line Business Practice Location Address:
340 15TH AVE E
Provider Second Line Business Practice Location Address:
#306
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-566-8732
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2009