Provider First Line Business Practice Location Address:
1009 8TH AVE N
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:
98109-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-631-2818
Provider Business Practice Location Address Fax Number:
206-631-2819
Provider Enumeration Date:
01/18/2011