Provider First Line Business Practice Location Address:
225 14TH AVE E
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:
98112-5275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-402-3168
Provider Business Practice Location Address Fax Number:
206-329-1256
Provider Enumeration Date:
09/17/2015