Provider First Line Business Practice Location Address:
1625 19TH AVE
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:
98122-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-323-5770
Provider Business Practice Location Address Fax Number:
206-328-6871
Provider Enumeration Date:
07/21/2005