Provider First Line Business Practice Location Address:
1117 MINOR AVE
Provider Second Line Business Practice Location Address:
DEARBORN CARRIAGE HOUSE
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-979-3172
Provider Business Practice Location Address Fax Number:
206-386-2202
Provider Enumeration Date:
12/31/2006