Provider First Line Business Practice Location Address:
4742 42ND AVE SW, #224
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:
98116-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-595-4181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2010