Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST # B242
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:
98195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-616-6996
Provider Business Practice Location Address Fax Number:
206-616-9520
Provider Enumeration Date:
11/16/2006