Provider First Line Business Practice Location Address:
315 1ST AVE W STE A
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:
98119-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-8647
Provider Business Practice Location Address Fax Number:
206-285-6854
Provider Enumeration Date:
02/28/2011