Provider First Line Business Practice Location Address:
1236 S JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-324-3009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2009