Provider First Line Business Practice Location Address:
1611 7TH AVE W
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:
98119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-612-4818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2008